The High-Superior-Tension Technique: Evolution of Lipoabdominoplasty

Abstract

Because abdominoplasty is associated with complications such as seroma and necrosis as well as epigastric bulging and a suprapubic scar located too high, the demand for this procedure is not as high as it otherwise might be. However, although these negative effects were common many years ago, their incidence has decreased dramatically with modern abdominoplastic techniques. One approach using a combination of abdominoplasty and liposuction or lipoabdominoplasty has resolved many of the problems faced with earlier techniques, offering aesthetically pleasing results and excellent reliability. The keys to successful lipoabdominoplasty, first developed as the high-superior-tension technique, are extensive liposuction, preservation of lymphatic trunks, preaponeurotic epigastric dissection, major muscle fascia plication, two high-tension paraumbilical sutures, hypogastric tension sutures, and closure of the dead spaces. The most recent updates to this technique are described in this article.

Plastie abdominale en deux positions

“…L'apport de la lipoaspiration combinée à l'abdominoplastie a déjà été largement décrit dans la littérature [5,6]. La lipoaspiration permet une meilleure définition de la silhouette en traitant les lipoméries non accessibles à la résection.…”

“…Elle permet également d'amincir le lambeau sus-ombilical et d'en faciliter sa translation inférieure pour un décollement latéral moindre. Enfin, réalisée sous le lambeau sous-ombilical qui sera réséqué, elle préserve les vaisseaux lymphatiques et diminue l'incidence des séromes postopératoires [6,7]. Cependant, la réalisation première d'une lipoaspiration dorsale en décubitus ventral lors d'une plastie abdominale ne semble pas être une intervention fréquemment proposée [2].…”

Cosmetic Body Lift

“…The preoperative marking is incised, and the inferior flap is suction dissected to the greater trochanter; this dissection may be extended, depending on thigh lipodystrophy and ptosis. [4][5][6][7][8][9] The superior flap is dissected to a point congruent with the anterior abdominal flap dissection; however, the dissection may extend above this point, depending on adipose tissue deposition. The patient is flexed at the hip.…”

“…Discontinuous undermining with a liposuction cannula is always performed for lateral attachments. [4][5][6][7][8][9] The rectus diastasis is plicated with a no. 0 barbed suture in two segments: xyphoid to umbilicus and umbilicus to pubis.…”

“…Despite the treatment of flank lipodystrophy, lateral skin laxity persisted. [4][5][6][7][8][9] As such, surgeons are frequently required to excise lateral skin excess (or dog-ears) during a second operation. 10,11 Initially, Hunstad and Repta suggested a singlestage, 270-degree, extended abdominoplasty to contour significant lateral truncal skin laxity and lipodystrophy for the non-massive weight loss population 12 ; this approach addressed a degree of ptosis that a standard abdominoplasty would not manage and a circumferential lower body lift would be too aggressive 13 To supplement the outcomes of an extended abdominoplasty, Shestak 14 and Mejia and Cárdenas Castellanos 15 have separately discussed the value of adding liposuction; they report an equivocal complication profile to Lockwood's high-tension lipoabdominoplasty with optimal lateral flank contouring.…”